Heart failure is a clinical syndrome which is a major cause of morbidity and mortality throughout the world. Autonomic nervous system (ANS) dysfunction is common in heart failure, and is believed to be a cause of disease progression and sudden death. Noninvasive measures of ANS tone, such as heart rate variability and sleep, have shown promise in predicting sudden death. However, there is little understanding of the links between heart rate variability and ANS activity. Moreover, while it is believed that heart rate variability reflects ANS function and ANS is strongly influenced by the central nervous system, the brain sites which are activated in response to these ANS abnormalities have not been identified in hear failure patients. The applicant's research has concentrated on advanced heart failure and sudden cardiac death using a non-invasive measure of ANS tone, heart rate variability. The applicant has become increasingly aware that to continue research in this area and to enhance her abilities to train future nurses, she must greatly increase her knowledge in the theory and practice of neurocardiology. Unfortunately, the applicant's undergraduate and graduate training did not prepare her for studies neurocardiology. Aspects of sleep, neuroanatomy, neural control of cardio-respiratory function, functional magnetic resonance imaging of the brain, and survival statistical techniques were seldom discussed. Thus a 3-year training plan is proposed which would incorporate formal classes in neurology, neuroanatomy, and survival and large clinical trial statistical analytic techniques with independent study with recognized experts in the areas of sleep research and brain imaging. To compliment the applicant's training, 2 studies examining the relationship of heart rate variability to sleep and central nervous system brain activity in advanced heart failure patients will be performed during the period of the award. The opportunity to increase the applicant's expertise in neurocardiology, specifically in the areas of sleep and brain imaging, will contribute both to her research as well as to the training of advanced practice nurses and doctoral students in nursing. In addition, this area of research could assist in the identification of triggers or markers of increased sudden death risk in heart failure patients and lead to the development of alternative therapies to minimize or prevent disease progression and mortality in this high risk patient population.